MEDICARE: ARCADIA COUNSELING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	11071	AZ
2	1041C0700X	Clinical Social Worker	11676	AZ
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1205999430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCADIA COUNSELING CENTER

Provider Business Mailing Address
First Line	:	3610 N. 44TH ST
Second Line	:	#120
City	:	PHOENIX
State	:	AZ
Zip	:	85018
Country	:	US
Telephone Number	:	602-218-6901
Fax Number	:	602-218-6901

Provider Business Practice Location Address
First Line	:	3610 N. 44TH ST.
Second Line	:	#120
City	:	PHOENIX
State	:	AZ
Zip	:	85018
Country	:	US
Telephone Number	:	602-218-6901
Fax Number	:	602-218-6901

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	GREGORY SCOTT GIBSON
Credential	:	MA, LPC
Telephone Number	:	602-218-6901

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	05/10/2011

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Directions to “ARCADIA COUNSELING CENTER ” Practice Location

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